Plné znění - 241/2006 Sb.

Xxxxxxxxxxxxx xxx xxx Assessment xx Xxxxxxxxxxxx xxx xxx Xxxxxxxxx xx Xxxxxxxxx Xxxxxxx xx Xxxxxxx xx Criminal Xxxx pursuant xx Xxx No. 209/1997 Xxxx., xx the xxxxxxxxx of fulancial xxxxxxx to the xxxxxxx xx xxxxxxxx xxxx xxx xx xxxxxxxx xxxxxxx xxxxx xxxx, xx amended

Dear Xxx/Xxxxx,

Xx xxxxxxxxx xxx xxxxxxxxx you xxxx xxxxxxxx questions in xxxx current xxxxxxxxx. Xxxxxxx, filling in xxxx xxxxxxxxxxxxx is xxxxxxxx for xxx xxxxx xxxxxxxxxx xx xxxx xxxxxxxxxxx xxx xxx xxxxxxxxx xx xxxxxxxxx support xxxxxxxx xx Xxx no. 209/1997. Thank you xxx xxxx cooperation; xx is xxxxxx xxxxxxxxxxx.

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X. Xxxxxx legibly xxxx xx xxx xxxxxxxx xxxx xx xxx xxxxxxxxx - x.x. xxx victim xx the xxxxxxxx xxx xxx xxx xxxxxxxx xxxxxx xxxx, xx the xxxxxxxx xx x xxxxxx xxx has xxxx xx xxxxxxxxxxx xx xxx criminal xxx:

1. Xxxxxxx:

2. Given xxxx:

3. Xxxx xx birth:

4. Xxxxxxxxx address:

5. Mail xxxxxxxx xxxxxxx (should xx xxxxxx xxxx xxx xxxxxxxxx xxxxxxx, xxxx):

6. Phone Xxxxxx:

7. X-xxxx xxxxxxx:

8. Xxxxxxxxxxx:

XX. Xx the xxxxxxxxx xx represented by xxxxxxx xxxxxx ("xxxxxxxxxxxxxx") xx xxx basis xx xxxxxxxxx xxxxxxxxxxxxxx (xxx xxxxxxxx, x xxxxx xxxxx xxxxxxxxxxx xx xxx/xxx parent) xx xx xxx xxxxx xx x xxxxx xx xxxxxxxx, xxxxxx xxxx in xxx xxxx of xxxx xxxxxxxxxxxxxx:

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Xxxxxxxxx xx registered xxxxxxx:

Xx xxx representative xx xxxxxx xxx xxxxxxxxxxx xx xxxxxx of xxx xxxxxxxxx, xxxxxx xxxx xxxxxx x xxxxxxxx xxxxxxxxxxx xxx/xxx xx represent the xxxxxxxxx - a xxxx xx x xxxxx of xxxxxxxx (xxx xxxxxxxxxxx xxxxxxxxxxxxxx) xx a copy xx the birth xxxxxxxxxxx (xxx statutory xxxxxxxxxxxxxx) xx any xxxxx xxxxxxxxxx document.

III. Xx xxx applicant xx a survivor xx x xxxxxx xxx xxx died xx xxxxxxxxxxx xx xxx respective xxxxxxxx xxx, xxxxxx fill xx the xxxxxxxx xxxx of the xxxxxxxx:

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Date of xxxxx:

4. Xxxx xx xxxxx:

5. Xxxx xxxxxxxxx xxxxxxx:

6. Xxxxxxxxxxx:

7. Relationship xx xxx xxxxxxxx xx xxx xxxxxxxxx (x.x. xxxxxx, xxxxxxxx, xx xxxxxxxxxx living xx xxxxxx household)

If xxx xxxxxxxxx is x survivor xx x xxxxxx who xxxx xx xxxxxxxxxxx xx the xxxxxxxx xxx, xxxxxx attach x copy xx xxx xxxxx certificate xxx xxx xxxxxxxxx xxxxxxx xxxx xxx xxxxxxxx xxxxxxxxx xx xxx an xxxxxxxxxx xx xxxxxxx the xxxxxxxx (in the xxxx xx x xxxxxx-xxxxx xxxxxxxxxxxx, such xxxxxxxxx xxxxxxx xxxxx xxxxxxxxxxxx or a xxxxx decision xx xxx xxxxxxxxxx xx xxxxxxx the xxxxxxxxx; xx xxx xxxx xx married xxxxxxx, xxxxxx attach x xxxxxxxx certificate).

Xxxxxx specify xxx xxxx xx which xxx xxxxx was xxxxxxxxx xxx, xx xxx xxxxxx xxxxxxx xxxxx the xxxxxxxxxxxx xx the crime xx x xxxxx xxxx, xxxxxx also xxxxxxx xxx xxxx xxx xxx xxxxxx xx xxxxx the xxxxxx xxxxxxx xx xxxx consequences (x.x., xxx xxxx of xxx xxxxxxx report).

VI. Xxxxxx specify xxx xxxxxxxx xxxxxxx xxxxxxxxx (x.x. xxxxxx, xxxxxx xxxxxxxxxx'x xxxxxx, court) xxxxx most xxxxxxxx xxxxxxxxx xxxxxxxx xxxxxxxxxxx. Xxxxx xxx xxxxxxxxx xxxxxx of xxx xxxx xxxxxxx xx xxx respective xxxxxxxxxxx.

Xx xxxxxxxxx, xxxxxx xxxxxx xxx xxxxxx xxxxxxxx xx xxx xxxxxxxxxxxxxx xxxxxxxx xxxxxxx authority xxxxx xxxxx xxxxxxxx xxx xxxxx xx xxx xxxxxxxxxx xxxxxxxxxxx (x.x. resolution xx xxx discontinuation xx xxxxxxxx xxxxxxxxxxx, xxxx xx xxx xxxxxxxxxx, xxxxxxxxx - xxxxx xx xxxxxxxxx).

Xxxxxxxxx xx xxx xxxxxxxxxx xx §8 xx Xxx no. 209/1997, xxx xxxxxx xx xxxxxxxxx support xxx xx reduced xx xxxxxxxx xxxxxxxxx xx xxxxxxx the victim xxx made use xx xxx xxxxx xxxxxxxx xx xxxxxxx x claim for xxxxxxxxxxxx xxxxxxx xxx xxxxxxxx xx any xxxxx person responsible xxx xxx xxxx xxxxxxxx. Xx not xxxx xx xxxx xxxx xx xxx xxxxxxxx xxx xxx xxxx identified.

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Fill xx xxxx XxXx if xxx xxxxxxxxx is x xxxxxxxx xx xx xxxxxxxxxx xxx xxx xxxx in xxxxxxxxxxx xx xxx xxxxxxxxx xxxxx.

1. Xxx xxx x xxxxx, xxxxxx xx xxxxx of the xxxxxx xxx xxxx xx xxxxxxxxxxx xx xxx xxxxxxxx xxxxxxx?

2. Xxx you xxxx xx x xxxxxx xxxxxxxxx xxxx xxx xxxxxxxx xxxxxx xxxxx xx xxx xxxxxxxxxx xx xxx crime?

3. Xxxx xxx a xxxxxxxxx xx xxx xxxxxx xx xxx xxx xxxxxxxx xxxxxxx xx xxxxxxx you?

4. Xx xxx other xxxxxxx xxxx xxx xxxxxxxxxx xxxxxxxxx xx xxxxxxx 1 to 3? Xxxxxx xxxx xxxxx xxxxxx, if xxxxx to xxx.

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Xxxxxxxxx xx the xxxxxxxxxx xx §2, xxxxxxx 2 xx Xxx xx. 209/1997, a xxxxxx who xx x survivor xx x victim xxx xxxx xx consequence xx a criminal xxx is xxxxxxxxxx xx be x xxxxxx if xx xx xxx xx x xxxxxx, spouse xx xxxxx of xxx xxxxxxxx and xxxxx with him xx xxx xx xxx xxxx household xx if xxx xxxxxx was x xxxxxxxxx xx xxx xxxxxxxx xx xxx xxxxxxxx xxx required xx xxxxxxx xxx xxxxxx.

Xx xxx applicant xx the victim xx x xxxxx xxx has xxxxxxxx xxxxxx harm, xxxxxx xxxx xx xxxxx XX - XIV.

Xxxxxx attach x xxxxx-xxxxx assessment xx pain and xxxxxxxxx pursuant xx Xxxxxx Xx. 440/2001 Xxxx. The respective xxxxxxxx xxxxxx xx xxxxxxxx xxxx xxx xxxxxxxxx xxxxxxxxxxx xxx xxx xxxxxx'x xxxxxxxxx. Xxxx xxxxxxx report xxxx xxxxxxx a xxxxx-xxxxx xxxxxxxxxx xx xxx xxx xxxxxxxx xxx x point-based xxxxxxxxxx xx xxx xxxxxxxx of the xxxxxx'x xxxxxx xxxxxxxx. Xxxxxx xxxx xx xxxx that only xxx xxxxx-xxxxx xxxxxxxxxx xx xxx xxx xxxxxxxx is xxxxxxxx xxx xxx xxxxxxxx xx Xxx xx. 209/1997. Xxxxxxxxx to xxx xxxxxxxxxx xx §6, xxxxxxx 2 xx Xxx no. 209/1997, xx xxxxxxxxx xxxxxxx xxxx be xxxxxxxx xxxxxx xxx xxxxx assessment xx xxx xxxx xxxxxxxx xx xx xxxxx 100 points.

The xxxxxx xxx obtain xxxx xxx xxxxxxxxx xxxxxxx in xxx xxxxxx of XXX 25,000 or xx xxxxxx equal xx xxx xxxxxx costs xx xxxxxxx xxxxxxxxx xxx xxxx xxxxxx (§7, section 1, xxxxxx x xx Xxx Xx. 209/1997 Xxxx.). xx xxx xxxxxx to xxxxx xxx a lump xxx xxxxxxx, xxxxx xx xx xxxx xx fill xx xxxxx XXX - XxX.

This includes xxx expenses for xxxxxxxxxx, xxxxxxxx xxxxxxxxx, xxxxxxxxxxxxxx xxxxx, hiring xx assistant xx xxxx xxx xx xxx xxxx xx xxxx xxxxxxx treatment, xxxxxxxxx transportation xxxxx xxx., xxxxxxxx such xxxxx xxxx xxx xxxx paid xx xx xxxxxxxxx xxxxxxx. xx xxxx expenses xxx xxx xxxxxx xx xxxxxxxxxxx evidence, xxx Ministry xx Xxxxxxx xxx not xxxx xxxx xxxx xxxxxxxxxxxxx.

Xxxxxx xxxxxx xxx xxxxxxxxx xxxxxxxxxx xxxx facts xx xxx xxxxxxxxxxx.

Xx xxx xxxxxxxxx xx an xxxxxxxx, xxxxx xxxxxxxxx xxxxx include a xxxxxxxxx from his/her xxxxxxxx describing the xxxxxxx xxxxxx according xx §351 et. xxx. xx Xxx xx. 262/2006, xxx Xxxxx Xxxxxx Code, xx xxxxxxx. xx xxx applicant is xxxx-xxxxxxxx, xxxx xxxxxxxx xxxxx xx x xxxx of xxx/xxx xxxx recent tax xxxxxx. lf the xxxxxxxxx xx x xxxxxxx person who xx xxxx xx xxxxx xxx/xxx xxxxxxxx xxxxxx standing, xxxxxx xxxxxx a document xxxxxxxxxx the xxxxxx xx xxx xxxxxxxxxx xxxxxxx. lf for xxx xxxxxx the xxxxxxxxx'x xxxxxx xxxxxxxxx xxxxxx be xxxxxx, xx xxxxxxxxxxx xxxxx xx affidavit may xx xxxxxxxx.

Xx xxxxxx standing has xxxx xxxxxxxx as x result of xxx xxxxxxxx xxx xx xxxxx X xxx x xxxxxx. X xxxx not xxx xxxx compensated xxx xxx harm 1 xxxx xxxxxxxx xx x xxxxxx xx the xxxxxxxx xxx.

X hereby xxxxxx xxxx X xxxx xxx xxxxxx xxx xxxxx for xxxxxxxxx xxxxxxx xx xxx xxxxxxx claim xxx xxxxxxxxxxxx xxx xxx xxxx xxxxxxxx as x xxxxxx xx xxx xxxxxxxx act xx xxx xxxxxxx xxxxx than xxx Xxxxx Xxxxxxxx.

X xxxxxxxxxxx xxxx xxxxxxxxx xx §12 of Xxx Xx. 209/1997 Xxxx., xx xxx xxxxxxxxx xx xxxxxxxxx support xxx xxx xxxxxxx xx xxxxxxxx acts xxx xx xxxxxxxx xxxxxxx xxxxx xxxx, xx xxxxxxx, X xx obliged xx xxxxxxxxx xxx Xxxxxxxx xx Xxxxxxx xxx xxxxxx xxxxxxxx as xxxxxxxxxxxx for the xxxx suffered, xx xx the xxxxxx xx xxx financial xxxxxxx, xxxxxx xxxx xxxxx xxxx xxx xxxx xx xxxxxxxxx xxx xxxxxxx xxxxxxx. X xxxx xxxxxxxxxxx xxxx, xxxxx the xxxxx xx xxx xxxx-xxxx xxxxxx, X xxx file an xxxxxxxxxxx xxxxxx xxx Xxxxxxxx of Justice xx xxxxx xxx xxxxx'x xxxxx for xxx xxxxxx xx xxx provided xxxxxxx, xxxxxx xxxx x xxxxxx xx well xxxxxxxx by xx xxxxxx xxxxxxxx, the xxxxx extent xx xxxx xxxxxxxx and xxx amount of xxxxxxxxxxxx xxxxxxxx.

X xxxx xxxxxxxxxxx that consciously xxxxxx xxxxx xx xxxxxxxxxx xxxxxxxxxxx or xxxxxxxxxxx xxxxxxxxxxx xxx xxx xxxxxxxx xx xxxxxxxxxxxxx xxxxxxx xxxxxxxx xxx xxxxxxxxx an xxxxxxx xxxxxxxx xx §21, section 1, xxxxxx c) xx Xxx xx. 200/1990 Xxxx., xx offences xx amended.

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Signature xx xxx applicant or xxx/xxx xxxxxxxxxxxxxx

- Xxxx xxxxxxx of xxx xxxxxxxxxxx xxx the xxxxxxxxx xx financial xxxxxxx pursuant to Xxx Xx. 209/1997, xxx Ministry of Xxxxxxx xxxxx xxxxxxx xxxxxxx xxx xxxxxx xx a xxxxxx xxxxxx. Subsequently, xxx Xxxxxxxx shall xxxxxxxx xx investigation with xxx police xx x xxxxxxx authority xx xxx the xxxxxxxx xxxxxxx of xxx xxxx. Xxxxxx xxxxx months xxxx xxx date xx xxx xxxxxxx of xxx application xxx xxxxxxxxxx xx xxx xxxxxxxxx xxxxxxxxx, xxx Xxxxxxxx shall xxxxxx xxxxxxx the xxxxxxx xx xxxxxx the xxxxxxxxx of xxx xxxxxxx xxx such xxxxxxx has been xxxxxxxx.

- Xxx xxxxxxxxx xxxxx xx xxxxxxxxxx x xxxxxx xx xxx Xxx Xx. 209/1997 Xxxx. only xx xx/xxx has xxxxxxxx xxxxxx xxxx xx x xxxxxx xx the xxxxxxxxxx xx x crime. X necessary xxx xxx xxx ohly xxxxxxxxx xxx the xxxxxx'x receipt xx xxxxxxxx support xxxxx xx xxx xxxxxx xx xxx xxxxx-xxxxx xxxxxxxxxx of the xxx suffercd (xxx xxx weakening of xxxxxx position), which xxxx be xx xxxxx 100 xxxxxx. Xxxxxxxxx xx x xxxxxx xxx xxx xxxx in xxxxxxxxxxx xx x xxxxx xxxxx be xxxxxxxxxx xx xx x xxxxxx if xxx xxxxxxxx xx x xxxxxx, xxxxxx xx xxxxx xx xxx xxxxxxxx and xxx xxxxxxxx xxxxxx x xxxxxxxxx with xxx xxxxxxxx xx xxx xxxx of xxx/xxx xxxxx xx xx xxx xxxxxxxx xxxxxxxxx xx xxx required xx support the xxxxxxxx.

- Xxx Xx. 209/1997 Coll. xx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx xx xxxxxxx of xxxxxxxx xxxx xxxxxxxxxx x xxxxxxxxxx term xx 1 xxxx from xxx xxxx on xxxxx xxx xxxxxx xxxxxxx of xxx xxxx xxxxxx by xxx xxxxx. Xx xxxx xxxx xxxx xxx xxxxxxxx xxxx xxx xxxx xx xxx commitment xx xxx xxxxx, xxx xxxxxx xxxxx xxxxxxx xxxxxxxx xx xxx xxxx xx which xx/xxx xxxxxxx xx xxx xxxxxxxxxxxx. The Xxxxxxxx xx Xxxxxxx xxxxxx xxxx xx xxxxxxxxxxx for xxx xxxxxxxxx of xxxxxxxxx xxxxxxx xxxxxxxx anytime xxxxx xxx xxxxx xx the xxxxxxxxxxxxxx xxxxxx.

- Xxxxxxxxx support xx xxxxxxx xxx xx x xxxxxx xxx xxx xxxxxxxx xxxxxx xxxx xx x xxxxxx xx xxx xxxxxxxxxx of x xxxxx xxx xx xx xxx xxxx xx x xxxx xxx amounting xx XXX 25,000 xx xx xxxxxx xxxxx xx xxxx xxxxxx xx the xxxxx of xxxxxxx xxxxxxxxx xx proved xx xxx xxxxxx, xxxxxxx xx any xxxxxx previously xxxx xx xxx victim xx xxxxxxxxxxxx xxx xxx harm xxxxxxxx. Xxx total xxxxxx xx xxxx xxxxxxx xxxx xxx xxxxxx XXX 150,000. If, xxxxx xxx provision xx xxxxxxx, xxx xxxxxx proves that xxx harm xxxxxxxx xxxxxxx the amount xxxxxxxx, xxx victim xxx receive xxxxxxxxxx xxxxxxx up xx xxx xxxxxx xx XXX 150,000 xx xx/xxx applies xxx xx within the xxxxxxxxxxxxxx xxxxxx of xxxx (x.x., 1 xxxx xxxx xxx xxxx xx xxxxx xxx xxxxxx learned xx the harm xxxxxx xx xxx xxxxx); xx xxxx xxxx, any amounts xxxxxxx xxxx xxxx xx xxxxx xxxx xxxxxxx.

- Xx xxxxxxxxxx xxx xx a xxxxxxxx xx x xxxxxx xxx xxx xxxx xx x xxxxxx xx xxx xxxxxxxxxx xx a xxxxx (x xxxxxx, xxxxxx xx xxxxx xx the deceased xxxxxx xx x xxxxxx xxxxxxxxx with xxx deceased xx xxx time xx xxx/xxx xxxxx xx xxxxxxxxx xx or xxxxxxxx xx xx xxxxxxxxx xx xxx xxxxxxxx) xxxxx be xxxxxxxx with a xxxx xxx xxxxxxxxx xx XXX 150,000. Xxx xxxxx xxxxxx xxxxxxxx xx xxxxxxxxx xxxxxxx xxxxx not xxxxxx XXX 450,000; xxxxxx the xxxxxx xx xxxxxxx xxxxxx xxxxx, the amount xxxxxxxx per xxxxxx xxxxx xx reduced xxxxxxxxxxx.

- Act Xx. 209/1997 Coll. xxxx xxx xxxxxxx xxx xxxxxxxxx of xxx xxxxxxxxx xxxxxxxxx of xxxxxxxxx xx motor xxxxxxxx xxxxxxx to xxxxxxxxxx xxxxxxxxx xxxxxxxxx. Xx matters xxxxxxx xx xxxxxxx accidents, xxxxxxxxxxxx for insurance xxxxxxxx should xxxx xx xxxxxxxx to xxx xxxxxxxx providing xxxx xxxxxxxxx xxxxxxxxx. Xxxx xx xxxxxxxx xxxxx, xx view xx xxxxxxxxxxx xxxxxxxxxxxxx, xxx xx application xxx xxx provision xx xxxxxxxxx support xx xxxxx with xxx Xxxxxxxx xx Xxxxxxx.

- Please bear xx xxxx xxxx xxx xxxxxxxxx xxxxxxxxx xxx xxxxxxxxxxxxx xxxxxxxx xxx the respective xxxxx xxxx be xxxxxxxx xx xxx xxxxxxxxxxx. Xx xxx xxxxxxxxx fails xx xx so, xxx Xxxxxxxx of Xxxxxxx xxxxxx xxxxxxxx xxxxxxx xxx xxxxxxxxxxx. Xxxxxx xxx xxxxxxxxx xxxx xx deliver xxx xxxx documents xxx xxxxxxxxxxxxx even within x supplementary xxxxxxxx, xxxx xxxx may xxxxxxx x xxxxxxxx xx xxxxxxxx xxx xxxxxxx as per Xxx Xx. 209/1997 Xxxx. Xxxx xxxxx xxx, xxxxxxx, prejudice xxx filing xx xxxxxxx xxxxxxxxxxx.

- Xxxxxx xxxx xx xxxx xxxx the applicant xxxxx xx obliged xx xxxxxx any xxxxxxxxx amount xxxxxxxx xx compensation xxx xxxx (xxxx xxx xxxxxxxx, xxxxxxxx etc.) xx xxx account xx the Xxxxxxxx xx Xxxxxxx xx xx the xxxxxx xx xxx xxxxxxx xxxxxxxx. This obligation xxxx xxx xxxxx xx xx/xxx xxx xxx received xxx xxxxxxxxxxxx. Xx xx xxxxxxxxx by xxx xxxxxx in xx xxxxxxxxxxx, xxx Xxxxxxxx xx Justice xxx xxxxx xxx xxxxx'x xxxxx to xxxxx xxx return xx xxx financial xxxxxxx xxxxxxxx xxxxx xxx xxxxx xx the xxxx-xxxx xxxx, provided xxxx a waiver xx xxxxxxxxx xx xxx xxxxxx'x social xxxxxxxx, xxx total xxxxxx xx the xxxx suffered xxx xxx xxxxxx xx xxxxxxxxxxxx paid to xxx xxxxxx.

Xxxxxx xxx/xxxx/xxxxxx

Xxxxxxxxxxxxxxx xx, že x xxxxxxxx, x xxxxxx xx xxxxxxxxxx, xxx xxxxxx Xxx xxxxxxxxx xxxxxxxxxxxx otázkami. X xxxxxx xxxxxxxx xxxxxxxxx Xxxxx xxxxxxxx x xxxxxxxxxxx xxxxxxxx xxxxxx xxxxxxx xxxxxxxx xxxxxxxx xxxľx zákona č. 209/1997 Zb., xx xxxx xxxxxxxxx xxxxx xxxxxxxxx nevyhnutné. Xxxxxxxx Vám xx xxxxxxxxxx, xxxxx xx xxxxx xxxxxx.

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X. Prosím, xxxxxxx čitateľne osobné xxxxx x xxxxxxxľxxx - xxxxx xxxxxxxxx xxxx, xxxxxx xxôxxxxxx xxxx na xxxxxx, xxxxx xxxxx xxxxxxxxxx xx xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx:

1. Priezvisko:

2. Xxxx:

3. Dátum narodenia:

4. Xxxxxx xxxxxxxx pobytu:

5. Xxxxxxxxxxxxxx xxxxxx (v xxxxxxx, xx xx xxxx xx xxxxxx xxxxxxxx bydliska):

6. Telefón:

7. X-Xxxx:

8. Xxxxxxxxxx:

XX. Ak xxxxxxxľx zastupuje xxx xxxxx (xxxxxxxx) xx xxxxxxx xxxxxxxxx xxxxxxxxxx (xxxx. xxxxxxxx dieťa xxxxxx xxxxxxx) xxxxx xx základe dohody x xxxxx xxxx, xxxxxxx xxxxx x xxxxxxxxxx:

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxxxxxxxxxxx adresa:

Ak žiadate xx xxx osobu, xxxx sa doložiť xxxxxxxxxx, ktorá xxxxxxxxxx xxxxxxx. Preto x xxxxxxxx xxxxxxxx xxxxx xxxxx xxxx (pri xxxxxxxx zastúpení) alebo xxxxx rodného xxxxx (x xxxxxxx zákonného xxxxxxxxxx) xxxxx xxx xxxxxxx listinu.

III. Ak xxxxxxxľ xxxxx osoba xxxxxxxxx xx osobe, xxxxx v xôxxxxxx xxxxxxxxx xxxx xxxxxxx, xxxxxxx, prosím, xx xxxxx x xxxxxxx xxxxx:

1. Priezvisko:

2. Meno:

3. Xxxxx xxxxxxxxx:

4. Dátum xxxxxx:

5. Xxxxxxxx bydlisko:

7. Xxxxxxxxxx:

8. V akom xxxxxx xxxx xxxxxxx xxxxx x xôxxxxxx xxxxxxxxx xxxx x xxxxx xxxxxxxľx (otec, xxxxx, xxxxx xxxxxx x xxxxxxxxx xxxxxxxxxx):

Xx xx xxxxxxxľ osobou xxxxxxxxxx xx xxxxx, xxxxx v xôxxxxxx xxxxxxxxx činu xxxxxxx, x xxxxxxxx sa xxxx xxxxxxxx xxxxx xxxxxxxx xxxxx x xxxxxxx, xxxxx xxxxxxxxx xxxxxxxxxx, xx xxxxxx xxxxx xxxxxxxxxx xxxxxxxxx xxxxx xxxxx xxxx xxxxxxxxx xx xxxxxxxxx (xx xxxxxx xxxxx - xxxxx xôxxx x xxxxx list xxxxx xxxxxxxxxxx xxxx x xxxxxxxxxxx xxxxxxxxxx, xxx xxxxxxxx xxxxx xxxxxxxx xxxx xxxxxxx xxxx a pod.)

IV. Xxxxxx, xx xxxxxxx xxxxxxxx xxxxxxx xxxxx xxxxxxxxxxxxxxx xxxxx alebo xxxxxxxx xx xxxxxxx xxxx; x xxxxx xxxxxxx láskavo xxxxxxx xxxxx Vášho xxxx.

X. Xxxxxx dátum, kedy xx xxxx xxxxxxxxx x škode spôsobenej xxxxxxxx činom.

Uveďte xxxxx xxxxxxxxx trestného činu x xx sa xxxx o xxxxx xxx xxôxxxxxxx xxxxxxxxx xx xxxxôx, xxxxxx xxxx x xxx (xxxxxxxxx z xxxxxxxxx xxxxxx - xxxxx xxx vystavenia).

VI. Xxxxxxx xxxxx xxxxx x xxxxxxxx xxxxxx (policajný xxxxx, xxxxxx xxxxxxxxxxxxxx, xxx), xxxxx xxxxxxxxx xxxxx konanie o xxxxxxxx čine. Uveďte xx xxxxxxx xxxxxx, xxx ktorou xxxxxxxx xxxxxxxxxxxx.

Xx xxxx x xxxxxxxxxx xxxxxxxx xxxxxxxxxxx xxxxxx činného x xxxxxxxx konaní, xxxxx xxxx xxxxxxxxx o xxx, x akom xxxxxx xx xxx xxxxxxxx (xxxx. xxxxxxxxx x xxxxxxxx trestného xxxxxxxx, opis xxxxxxxx, xxxxxxxx - i xxxxxxxxxxxxx), xxxxxxxx xx x xxxxxxxx.

XXX. Xxxxxx, xxxx spôsobom xxx xxxxxxxxx nárok xx xxxxxxx xxxxx od xxxxxxxľx xxxxx xxxx xxxxx, xxxxx xxxxxxxxx xx xxxxx.

Xxxľx xxxxxxxxxxx §8 zákona x. 209/1997 (Xx)., xxxxxxxx xxxxx xx môže xxxxxx alebo xx xxxxxxxx x prihliadnutím xx xx, xx xxxx využila xxxxxx xxxxxxx prostriedky xx xxxxxxxxxx nároku na xxxxxxx xxxxx xx xxxxxxxľx alebo inej xxxxx, ktorá xxxxxxxxx xx xxxxx. Tento xxx xxxxxxxxxxx, xx xxxxxxxľx trestného činu xxxxxxxxx.

Xxx VIII. Vyplňte, xx xxxxxxxľ xx xxxxxxxxxx xx xxxxx, xxxxx v xôxxxxxx xxxxxxxxx xxxx xxxxxxx.

XXXX. Xxxxxx, xx ste xxxxxxx osobou, ktorá xxľxx xxxxxxxxx xxxxxxx x §2 odst. 2 xxxxxx x. 209/1997 Xx., xxxxxxxx xxľxx osôb spľňa xxxxx xxxxxxxxx, xx xx Xxx tieto xxxxxxxxxxx xxxxx.

1. Xxxx xxx xxxxxxx, xxxxxxxx xxxxx dieťaťom xxxxx, xxxxx xxxxxxx v xôxxxxxx trestného xxxx?

2. Xxxx xxx x xxxxxx xxxxxxxxx činu xxxx xxxxxxxxx trestného xxxx x xxxxxxxxx xxxxxxxxxx?

3. Poskytovala Vám xxxx trestného xxxx xxxxxx, či xxxx x xxxx xxxxxxx?

4. Xxľxxxx xxxxx osoby xxxxxxxxxxx xxxxxxxxx 1 xx 3? Xxxxxx xxx počet, xx Xxx xx xxxxx.

Xxxľx xxxxxxxxxxx §2 odst. 2 zákona č. 209/1997 Xx. xx xx xxxx xxxxxxxx xxxxx xxxxxxxxx po xxxxx, xxxxx v xôxxxxxx trestného činu xxxxxxx, xx xx xxxxxxx, xxxxxxxx xxxxx xxxxxxxx xxxxxxxxx a xxxxxxx v xxxx xxxx xxxxx s xxx xxxx x xxxxxxxxxx alebo xxxxx, xxxxxx xxxxxx xxxxxxxxxx xxxxx xxx xxxxxxx xxxxxxxxxx xxxxxx.

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Xxxx XX. xx XXX. Vyplňte, xx xx xxxxxxxľ xxxx xxxxxx xxxxxxxxx xxxx a xxxx xx xxôxxxxxx ujma xx zdraví.

IX. Uveďte xxxxx, xxxx sa xxxxxxxx liečenie, xxxxxxxxxx xxxx xx skončila xxxxxxxx xxxxxxxxxxx.

X. Celková xxxxx xxxxxxxx xxxxxxxxxxx xx bolesť xxxx:

X xxxxxxxx xx xxxx xxxxxxxx bodové xxxxxxxxxxx xx bolesť xxxľx xxxxxxxx č. 440/2001 Zb., xxxxx xxxxxxxľ získa xx xxxxxx, xxxxx xx xxxxxxxxx. Xxxxx xxxxxxxx xxxxxxx xxxx obsahovať xxxxxx hodnotenie xxxxxxxxx xxxxxxx x xxxxxx xxxxxxxxxx xxxxxxxx xxxxxxxxxxxxx xxxxxxxxxx. Xxxxxxxxxxx, xx xxx xxxxx xxxxxx č. 209/1997 Zb. xx relevantné xxx bodové ohodnotenie xxxxxxxxx xxxxxxx. Xxxľx xxxxxxxxxxx §6 xxxx. 2 xxxxxx x. 209/1997 Xx. xxxxxxx xxxxxxxxx' peňažnú pomoc, xx xxxxxx xxxxxxxxxxx xxxxxxxxx bolesti xxxxxxxxxx xxxxxxxx 100 xxxxx.

XX. Xxxxxx, xx xxxxxxx x xxxxxxxxxxx xxxxxxxx xxxxxx xx xxxxx xxxxxxxxx čiastky 25 000.- Xx alebo xx xxxxxxxx xxxxx ušlého xxxxxxx x xxxxxxxx xx liečenie.

Podľa xxxxxxxxxxx §7 xxxx. 1 xxxx. x) xxxxxx x. 209/1997 Xx. xx xxxxxxx xxxxx xxxxx xxxxxxxxx peňažnú xxxxx xx xxxxx xxxxxxxxx xxxx 25&xxxx;000.- Xx, alebo vo xxxxx xxxxxxxxxxxxxx xxxxxxxxxxx xxxxxxxx na xxxxxxxx x xxxxxx zárobku. Xx sa rozhodnete xxxxxx o xxxxxxx xxxxx xx xxxxx xxxxxxxxx xxxxxxx, xxxxxxxx xx xxxxxxxxx xxxx XXX. - XIV. xxxxx dotazníka.

XII. Xxxxxxx xxxxxxx x liečením xxxxxx:

Xxx o náklady xx xxxxx, xxxxxxxxxxxx xxxôxxx, xxxxxxx xx xxxxxxxxxxxxx, xxxxxxxxx xxxxxx xxxxx na xxxxx x xxxxxxxxxx xx xxxxxxxxxx, zvýšené náklady xx dopravu, x xxx. pod podmienkou, xx tieto náklady xxxxxxxxx xxxxxxxxx. Tu xxxxxxx xxxxxxx xx xxxxx xxxxxxx, xxxx xx xx ministerstvo xxxxxxxxxxxxxx nebude xxxx xxxx xxxxxľ.

XXXX. Popište xxxxxxxxx pomery žiadateľa xxxx x xx xxxxxx xxxx xx xxxxxx spôsobenej xxxxxxxx xxxxx.

X xxxxxxxx xxxxxxxx xxxxxxx, xxxxx potvrdzujú xxxxxxx xxxxxxxxxxx.

X prípade, xx žiadateľ xx x zamestnaneckom xxxxxx, xôxxx o xxxxxxxxxx xxxxxxxxxxxxľx o priemernom xxxxxxx xxxľx §351 x xxxx. zákona x. 262/2006 Zb., xxxxxxxx xxxxx, x xxxxx xxxxxxxxxx predpisov. Xx xx xxxxxxxľ xxxxxx xxxxxxxxxx xxxxxxxxx xxxxxx, xxxxx listinou xxxx xxxxxxxxx opis xxxxxxxxxx daňového xxxxxxxxx. Xx žiadateľ poberá xxxxxxxx xôxxxxxx, dokladom, xxxxx xôxx xxxxxxx xxxxxxxx xxxxxxxx situáciu, xxxx xxxxxxxxxx x xxxxx starobného xôxxxxxx. X xxxxxxx, že x xxxxxxxx závažného xôxxxx nemožno xxxxxxx xxxxxxxxx xxxxxx xxxxxxxľx, x krajnom xxxxxxx xx xxxxx xxxxxxxx xxxxxxxxxx x nich xxxxxxx xxxxxxxxxx.

XXX. Xxxxxx xxxxx nemocenských dávok (xxxxxxxxxxx dôchodku) x xxxx, xxxxxx ich xxxxxxxľ xxxxxx, xx xxxxxxx po xxxxxx xxxx xx xxxxxx, xxôxxxxxxx trestným xxxxx.

X xxxxxxxx xxxxxxxx potvrdenie xxxxxxxxxxxxľx xxxxx xxxxxxxxx x xxxxx nemocenských xxxxx. X xxxxxxx, xx v xôxxxxxx xxxxx na xxxxxx xxôxxxxxxx trestným xxxxx Xxx xxxxxxxx xxxxxxxxx xôxxxxxx, xxxxxx x xxxxxxx jeho xxxxx.

Xxxx xxxxxxxxx pomery xx xxxx, xx xxxxxxxx xxxxx, xxxxxxx xxx xxx(x) xxxxxx, xx xxxx xxxxxxxx xxxxxxxx xxxxxxxx. Xxxxx, xxxxx xx xxxxx xxôxxxxx, xxxxxľ xxxxxx xxxxxxxx.

Xxxxxx xxxxxxxxxx, že xxxxx xx peňažnú xxxxx či xxxxxxx xxxxx xx xxxxxxxxxxx xxxx xxôxxxxxxx trestným xxxxx som neuplatnil(a) x žiadnom inom xxxxx ako x Xxxxxx (Slovenskej) xxxxxxxxx.

Xxxxxx xx xxxxxxx, že xx xxxľx xxx. §12 xxxxxx č. 209/1997 Zb., x xxxxxxxxxx xxxxxxxx xxxxxx xxxxxxx xxxxxxxx xxxxxxxx x x xxxxx x x doplnení xxxxxxxxxx zákonov, v xxxxx xxxxxxxxxx predpisov, xxxxxx xxxxxxxxx xx xxxxxxx rokov xxx xxx, xxx xx xxxxxxxx xxxxx, xxxxxxx xx účet Ministerstva xxxxxxxxxxxxxx xxxxxxx, ktoré xxx xxxxxx(x) xxx xxxxxxx škody, a xx xx xx xxxxx xxxxxxxxxxx pomoci. Xxxxxxx s xxx xxxxxx xx xxxxxxx, xx po uplynutí xxxxxxxxxx xäxxxxxxx doby xôxxx požiadať Ministerstvo xxxxxxxxxxxxxx, xxx xx x xxxx xxxxx xxxxxx xxxxx na xxxxxxxx xxxxxxxxxxx xxxxxx, xx moja xxxxxxxx xxxxxxxx bude xxxx xxxxxx xxôxxxxxxxx, xxxxxxx xxxxx xxxxx, xxxxx xx xxôxxxxxx x xxxxx náhrady, ktorú xxx dostal(a).

Beriem xxxx xx xxxxxxx, že xxxxxxxxx uvedením xxxxxxxxxxx xxxxx xxxxxxxxx xxxxx xx jeho xxxxxxxxx xx xxxxxx xxxxxxxx xxxxxxxxxxxx výhody, xx xôxxx xxxxxxxx xxxxxxxxxx xxxľx §21 odst. 1 písm. x) xxxxxx č. 200/1990 Xx., x priestupkoch, x znení neskorších xxxxxxxxx.

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xxxxxx xxxxxxxľx alebo xxxxxxxx

- Ministerstvo xxxxxxxxxxxxxx Xxxxx xxxxxxxxx xx xxxxxxx xxxxxxxx x xxxxxxxxxxx peňažnej xxxxxx xxxľx xxxxxx č. 209/1997 Zb. xxxxxxx jej príjem x xxxxx poradové xxxxx. Xxxxx xxxx xxxxxxxxxx xx polícii xx na inom xxxxxxxx xxxxxx xxxľx xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xx troch xxxxxxxx xx xxxxxx žiadosti x predložení xxxxxxxxxx xxxxxxxx xxx xxxxx xxxxxxxx xxxxx xxxxxxxľxxx xxxxxx xôxxxx, xxxxx xxxxx xxxxxxx xxxxxxxx.

- X xxxxxx xxxxxx č. 209/1997 Zb. xxxx xxxxxxxľ xxxxxxxxxx za obeť xxx x xxxxxxx, xx mu v xôxxxxxx trestného činu xxxx spôsobené xxxxxxxxxx xxxxxxx. Nevyhnutnou, xxx xxxx xxxxxxxxxxxx xxxxxxxxxx xx xxxxxxxxx xxxxxxxx xxxxxx xxxxx obeti xx výška bodového xxxxxxxxxxx xxxxxxx (xxx xxxx sťaženie spoločenského xxxxxxxxxx) xxxxxxxxxxxx aspoň 100 xxxxx. Za xxxx sa považuje xx xxxxx xxxxxxxxx xx xxxxx, ktorá x xôxxxxxx trestného xxxx xxxxxxx, xx xxxx xxxxxxx, xxxxxxxx xxxxx xxxxxxxx zomretého x xxxxxxx x xxxx jeho xxxxx x ním žila x xxxxxxxxxx, alebo xxxxx, xxxxxx zomretý xxxxxxxxxx alebo xxx xxxxxxx xxxxxxxxxx xxxxxx.

- Xxxxx č. 209/1997 Zb. o xxxxxxxxxx xxxxxxxxx xxxxxx xxxxxxx xxxxxxxx xxxxxxxx xxxxxxxxx xxxxxxxxxxx (xxxxxxxx) xxxx 1 xxxx xxx xxx, xxx xx xxxx xxxxxxxxx x xxxxx xxôxxxxxxx xxxxxxxx xxxxx. Xx xxxxx dňom už xxx je xxx xxxxxxxxx xxxxxxxxx činu, xxxx xxxxxxxx xxxxxxx, xxxx xx xx xxxxx. Xxxxxxxxxxxx xxxxxxxxxxxxxx xxxôxx xxxxxxxx xxxxxxxxxx x xxxxxxxxxxx peňažnej xxxxxx, ktoré mu xxxxxxxx xx xxxxxxxx xxxxxxxxxx xxxxxx.

- Xxxxx xx xx žiadosť xxxxx, xxxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx xxxxx xx xxxxxx, xxxxxxxx x xxxxxxxxx sume 25&xxxx;000.- Xx xxxxx vo xxxxx, xxxxx xxxxxxxxxxx xxxxxxxxxx xxxxxx xx xxxxxxx, xxxxxxxxxx xxxxxxx xxxxxxx s xxxxxxxx, xxxxxxx x xxxxx xxxxxxxx xxxxxxx, ktoré xxxx z titulu xxxxxxx xxxxx xx xxxxxxx; xxxxx xx xxxxxx súčte nesmie xxxxxxxxxx xxxx 150 000.- Xx. Xx xxxx - xx tom, xxx xxx poskytli xxxxx - xxxxxxxx, xx xxx xxxxxxxxx xxxxx xx xxxxxx xxx xx, xxxxx xxxx podkladom na xxxxxxxxxxx xxxxxx, na xxx žiadosť x xxxxxx stanovenej xxxxx xxxxxxx xxx možno xxxxxxxxx xxxxx opäť, x xx xx xx xxxxxxxxxx výšky 150&xxxx;000.- Xx; xxxxxx xx xxxxxxxxxx na xxxxxxx, xxxxx xx xxxx vyplatené.

- Fyzickej xxxxx, xxxxx je xxxxxxxxxx xx xxxxx, xxxxx v dôsledku xxxxxxxxx xxxx xxxxxxx (xx xxxx xxxxxxx, xxxxxxxx alebo dieťaťom xxxxxxxxx x zároveň x xxxx jeho xxxxx s xxx xxxx x domácnosti, xxxxx xxx xxxxxxx xxxxxxxxxx, či xxx xxxxxxx poskytovať xxxxxx), xx xxxxxxxx peňažná xxxxx x xxxxxxxxx xxxx 150 000.- Xx; xxxxx vo svojom xxxxx xxxxxx xxxxxxxxxx xxxx 450&xxxx;000.- Kč, x xx xx xxxxx xxxxx viac xxx tri xxxxx, xxxxxxxxxxx čiastka xx xxx xxxxxx xxxxx xxxxxxxxx kráti.

- Xxxxx č. 209/1997 Zb. nenahradzuje xxxxxxxx xxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxľx xxxxxxxxxx xxxxxxxx, xx xxxxx nadväzuje povinné xxxxxxx poistenie zodpovednosti. Xxxxx xx xxxxxxxx x xxxxxxxxxxxxxx xxxxxxxxxx xxxôx xxxxxx xxxxxxx, xxxxx xxxxxxxx poistenie xxxxxxxxxxxxx, o poskytnutie xxxxxxxxx xxxxxxx. Xxx x celkom xxxxxxxxxxx xxxxxxxxx x xxxxxxxxxxxxx xx xxxxxxxxx xxxxxxxxx xxxxxxxxx je xxxxx xxxxxx xxxxxxxxxxxx spravodlivosti x poskytnutie xxxxxxxx xxxxxx.

- Pripomíname, xx xx xxxxxxxxxx xxxxxxxx xxxxxx xxxxxxxx xxxxxxx x xxxxxxxxxx, xx xxxxx xxxxxxxxxx xxx xxxxxxxxxxxx položkách. Xx xxx žiadateľ neučiní, xxxxxxxxxxxx xxxxxxxxxxxxxx nemôže xxxxxxx xxxxxxx. Xx xxxxxx potvrdenia a xxxxxxx ani xxxxxxxxx xxxxxx, xxxx skutočnosť xôxx xxx xôxxxxx xxxxxxxxxxxxx peňažnej pomoci xxxľx xxxxxx č. 209/1997 Zb. Xx xxxx nevylučuje xxxxxxx xxxxx xxxx xxxxxxx.

- Xxxxxxxxxxxx, xx xx xxxx žiadateľovi xxxxxxxxxx xxxxxxx pomoc, xxxxxxxľ je xx xxxxxxx xxxxx odo xxx xxxxxxxxxxx pomoci xxxxxxx xx xxxx xxxxxxxxxxxx xxxxxxxxxxxxxx xxxx, xxxxx xxxxxx ako xxxxxxx xxxxx (xx xxxxxxxľx, poisťovne a xxx.) až xx xxxxx xxxxxxxxxxx pomoci. Xxxx xxxxxxxxx xxxx, xx xx xxxxx xxxxxxxxxx. Xx xxxxxxx xxxxxxxx xxxxx sa xxxxxxxxxxxx xxxxxxxxxxxxxx xôxx x mene xxxxx xx xxxxxxxx stanovenej xäxxxxxxx doby xxxxx xxxxx na xxxxxxxx xxxxxxxxxxx peňažnej xxxxxx. Xx xxxxxx xxxxxx xxôxxxxxxx sociálna situácia xxxxx, celková xxxxx xxxxx, xxxxx xxx xxôxxxxxx, x xxxxx xxxxxxx, xxxxx obeť xxxxxxx.